The impact of endoscopic brow lift on eyebrow morphology, aesthetics, and longevity: objective and subjective measurements over a 5-year period.

BACKGROUND: The longevity of a brow lift, its morphology, and its contribution to overall facial aesthetics have not been addressed in previous studies using both objective measurements and validated subjective aesthetic scoring systems. METHODS: Thirty-one patients with a 5.4-year follow-up after subperiosteal endoscopic brow lift were assessed by (1) objective measurements using computer software, (2) validated regional aesthetic scoring systems, and (3) global aesthetic scoring systems. RESULTS: In part 1, objective measurements confirm a subtle elevation of the brows at less than 5 mm (p<0.001) that persisted at 5.4 years after surgery in all areas except the tail of the eyebrow. In part 2, subjective regional aesthetic scoring indicated that the dimensional change is small but apparent to observers, and is maintained at 5.4 years; that depressor muscle resection with a brow lift provides a statistically significant reduction in glabellar lines, which is maintained at 5.4 years; and that a brow lift provides temporary improvement in forehead lines but that this improvement relapses to baseline at 5.4 years. In part 3, global aesthetic scores suggest that 64 percent patients are still judged as appearing better 5.4 years after a brow lift than before surgery. CONCLUSIONS: This is the first study to provide evidence from both objective measurements and validated subjective aesthetic scoring systems regarding the morphology, benefits, and longevity of endoscopic brow-lift surgery. This demonstrates that a brow lift produces a subtle elevation, with a natural eyebrow morphology close to the original, and with minimal long-term relapse except at the tail of the eyebrow. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

How long does a face lift last? Objective and subjective measurements over a 5-year period.

BACKGROUND: The longevity of face-lift surgery is a key question that has not been adequately addressed by previous studies. No study has used standardized photographs, objective measurements, or validated subjective scoring systems. METHODS: From 2001 to 2011, photographs were standardized in this institution. Fifty primary face-lift patients were assessed 5.5 years after surgery using objective measurements from standardized photographs, a region-specific subjective assessment (Scale Summit II scores), and an overall subjective assessment (Global Aesthetic Improvement Scores). RESULTS: For the first outcome measure, the jowl elevated in vertical height by 6 mm after face-lift surgery, with a relapse of 21 percent at 5.5 years. Jowl correction was maintained at 5.5-year follow-up (p < 0.0001). Cervicomental angle decreased by 13 degrees after face-lift surgery, with partial relapse of 69 percent at 5.5 years. For the second outcome measure, scores showed significant improvement in all areas following a face lift (jowl, nasolabial, and marionette, p < 0.0001; neck, p = 0.0007). At 5.5 years, no subjective worsening of any area was noted except the neck. For the third outcome measure, scoring suggested that 76 percent of patients will still appear younger 5.5 years after a face lift than they did before the face lift. CONCLUSIONS: This study indicates that differential regional aging occurs after face lifting, with the jowl, nasolabial, and marionette areas remaining well corrected at 5.5 years but with partial relapse of neck correction. Long-term global aesthetic assessment remains positive in the vast majority of patients. This study provides strong evidence that face-lift surgery can provide significant long-term aesthetic gains. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Craniosynostosis: a radiological and surgical perspective.

Craniosynostosis is the premature fusion of the cranial sutures. It is identified early in life either due to cosmetic deformity or due to more serious functional complications. Isolated forms of craniosynostosis are much more common and less challenging in their management than their syndromic counterpart. Modern multislice computed tomography and 3D reconstructions have revolutionized surgical planning and follow-up. We review the radiological features of the craniosynostoses, complications, and associated conditions that may alter patient management. Common surgical techniques and postoperative appearances are illustrated in the article.